Thursday, April 28, 2011

Wisconsin Republican Governor Scott Walker is famously engaged in a war against public workers in that state. Hawaii’s legislature, with no Republican governor to fear, is about to do a job on public workers (including themselves and their families) that will hugely profit health insurers. They are about to put near-monopoly insurers in charge of what treatments, surgery or medicines will be provided or denied in the state. What insurers deny, of course, is left to the patients to pay, if they can.

So Hawaii legislators are setting up public workers and others insured in the state for a significant transfer of private wealth into insurance company hands.

Hawaii has little effective competition for medical insurance but currently protects its citizens with laws that, among other things, provide for an external review of denials. This takes away the absolute power over life and death that the insurers previously wielded. The laws are responsible in part for Hawaii’s justified reputation as “the health state.”

In the bad old days before Hawaii passed its landmark Patients’ Bill of Rights and Responsibilities, health insurers, dominated by HMSA (Hawaii Medical Service Association), could routinely deny services to patients. Michael Moore’s Sicko could easily have been made here. With the passage of the new law, patients were protected by the ability to appeal denials to the Insurance Commission. Many turn-downs were reversed, and lives saved. The new law also moved the definition of medical necessity (what an insurance plan has to provide) into statute.

Dealing with cancer wasn't as painful for her husband as was the feeling that he wasn't worth the expense of treatment, says Melani Mendes of Paauilo on the Big Island.

His doctors requested a medical procedure that was denied four times by the Hawaii Medical Service Association, she said.

"He said, 'You know what it's like to have people deny medical treatment? They're telling me I'm not worth help. I might as well start preparing to die,'" she said.

HMSA ultimately paid all expenses, but not until after the couple spent their own money to go to Texas for medical help.

Mendes said her husband, Lloyd, 49, had had surgery three times in his neck for what was believed to be recurrent parathyroid cancer.

Five doctors agreed a magnetic resonant imaging study was needed to pinpoint the cancer.

Despite doctors' requests, HMSA refused to cover an MRI because medical directors gave an opinion "that an MRI would not detect recurrence of metastatic parathyroid cancer . . . "

Mendes paid his own expenses. Could you?

That’s the question state legislators should be asking themselves, because SB1274, now in conference committee, would remove the external right of review and return Hawaii to those bad old days.

Denials still happen, but patients have the right to make their case before a three-member panel at the Insurance Commission. They are also entitled to reimbursement of their attorneys fees, something that SB1274 will take away. Without reimbursement, patients would be better off paying for treatment themselves, out of their own pocket. Or just dropping dead, it’s definitely cheaper. But is that where we want to go?

It’s predictable that insurers, given the final say, will ramp up denials, since as Sicko and insurance company whistleblower Wendell Potter have shown, that’s how they make their profits.

In effect, without a Republican Scott Walker in Hawaii, state legislators are about to offer up, on their own, a public worker benefit cut that will profit health insurers. Those families with private plans and others would also be sold down the river if SB1274 becomes law.

In 2008 a similar attempt at defeating the right of appeal was mounted by Bob Herkes, chair of the House Corporate Consumer Protection Committee. Herkes is on the conference committee for SB1274 that will meet, likely for the final time, today at 2:30 p.m. Herkes has an interesting history with HMSA (click this link for a Google search). In fact, an “embedded lobbyist,” the Executive Administrator of HMSA Foundation, worked in his office as an “intern” at one time.

Other legislators, including conference committee members, have received significant campaign contributions from HMSA and others in the insurance industry. HMSA’s attorney has given testimony that legislators have chosen to rely upon in committee hearings, discounting experts in the field.

Nevertheless, the entire Legislature must vote on this bill. If they can imagine themselves or a family member in the position of Mr. Mendes, denied a life-saving procedure with no way to appeal, they should reject this bad bill.